Support

A cookie is a piece of data stored by your browser or device that helps websites like this one recognize return visitors. We use cookies to give you the best experience on BNA.com. Some cookies are also necessary for the technical operation of our website. If you continue browsing, you agree to this site’s use of cookies.

Events

Bloomberg Next marketing services allow clients to elevate their brands and extend their reach through our established and trusted expertise, enhanced with engaging event production, appealing design, and compelling messaging.

Enrollees in Failed ACA Nonprofits Would Be Exempt From Penalty Under Bill

Sept. 8 — People enrolled in failed nonprofit health plans created under the Affordable Care
Act would be exempt from paying penalties if they didn't re-enroll in qualified health
plans under
legislation approved Sept. 8 by a House committee.

The House Ways and Means Committee approved by voice vote H.R. 954 introduced by Rep.
Adrian Smith (R-Neb.), which the Joint Committee on Taxation estimates will cost a
mere $4 million over a 10-year period beginning in 2014. Democrats objected to the
legislation, saying it isn't clear how many people would benefit, because people who
lose coverage are eligible to re-enroll in plans using special enrollment periods,
or they could qualify for an exemption from the ACA's penalty for not having minimum
essential coverage based on financial hardship.

The failure of 16 of the 23 Consumer Operated and Oriented Plans (CO-OPs), which received
$1.7 billion in federal loans, has been one of many contentious points between Republicans
and Democrats. About 750,000 people were in CO-OP plans that have failed. Republicans
argued that the bill is narrowly tailored to ensure that people who enrolled in the
government-subsidized CO-OPs that failed between open enrollment periods wouldn't
have to pay a penalty if they didn't get coverage for the remainder of the year.

It isn't known when the full House may take up the legislation, but committee spokeswoman
Lauren Aronson told Bloomberg BNA Sept. 8 that Congress is only in session for about
three weeks before leaving to campaign for the elections, so consideration of the
bill is likely to be soon.

Penalties May Be Required

“Hundreds of thousands of American families depended on CO-OP plans for their health
insurance,” Ways and Means Chairman Kevin Brady (R-Texas)
said. “Now the plans they purchased have been terminated through no fault of their
own. And, if that's not painful enough, these Americans—and perhaps many more if additional
CO-OPs collapse—could be forced to pay the individual mandate tax penalty for not
having coverage. This is just wrong.”

Ranking member Sander Levin (D-Mich.) said the bill is “part of an overall attack
on ACA” by Republicans.

Levin sent a
letter to Treasury Secretary Jacob Lew and Department of Health and Human Services Secretary
Sylvia Mathews Burwell asking for more information on the impact of the midyear CO-OP
closures.

Andrew Slavitt, acting administrator of the Centers for Medicare & Medicaid Services,
replied Sept. 7 that five of the 16 failed CO-OPs failed before the end of the coverage year.
“We are working closely with the relevant state Departments of Insurance
(DOIs), the primary regulators of insurance in the states, to communicate quickly
and effectively with consumers to notify them of their eligibility for a Special Enrollment
Period (SEP) and to help them enroll into new coverage,” Slavitt said.

CO-OP Funding Cut by Republicans

Rep. Jim McDermott (D-Wash.) said congressional Republicans cut funding for the CO-OP
program by nearly two-thirds in 2013 and in 2014 blocked the administration from shifting
discretionary funding under the ACA's risk corridor program to protect insurers from
high-cost claims, which undermined the success of the CO-OPs.

Smith, the author of the bill, said he had heard from about 300 consumers in his district
after CoOportunity Health, which operated in Iowa and Nebraska, failed in 2015, many
of whom were concerned they would have to pay tax penalties for not having coverage
as well as having to pay annual deductibles twice. The bill is “about ensuring consumers
aren't caught in the crossfire.”

Rep. Xavier Becerra (D-Calif.)
said that not requiring people who lost coverage through CO-OPs to re-insure would
create a “two-tiered system” because people with health problems would be more likely
to find new insurance, while people without medical problems would have an incentive
not to seek coverage because they wouldn't be penalized.

“This bill would provide the wrong incentives to Americans,” Becerra said. “We want
people to get and keep insurance,” he said, “not encourage people to go bare.”

About 19 percent of individuals buying health plans on the ACA’s exchanges may have
only one insurer option for next year, according to the Kaiser Family Foundation.
That number is up from 2 percent this year.

Pinal County, Ariz., had been the first known exchange market to lose all carriers
for 2017. On Sept. 8, Arizona insurance department spokesman Stephen Briggs confirmed
in an e-mail to Bloomberg BNA that Blue Cross Blue Shield of Arizona will offer plans
on that area's exchange.

Dialysis Coordination Bill Approved

The Ways and Means Committee also approved by voice vote the Dialysis PATIENTS Demonstration
Act (H.R. 5942) sponsored by Rep. Todd Young
(R-Ind.). The bill would establish a voluntary pilot program within Medicare for end-stage
renal disease patients to get coordinated care while continuing to receive current
benefits.

More than 650,000 people receive dialysis a year to treat kidney failure, and the
bipartisan legislation would save patients time, money and multiple trips to providers'
offices while producing better health outcomes, Young said.

McDermott was among the few who objected to the bill, saying that “nonprofit kidney
care facilities worry this bill would unfairly benefit the big for-profit companies,”
such as DaVita Inc., at the expense of the small providers. The nonprofits would not
have the capital necessary to bear the risk and participate in the coordinated care
models under the bill, he said.

To contact the reporter on this story: Sara Hansard in Washington at
shansard@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at
kcasey@bna.com

All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to books@bna.com.

Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)

Notify me when updates are available (No standing order will be created).

This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to research@bna.com.

Put me on standing order

Notify me when new releases are available (no standing order will be created)